Provider Demographics
NPI:1295399350
Name:STAMP, WALTER HARRIS II (LGPC, MA)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:HARRIS
Last Name:STAMP
Suffix:II
Gender:M
Credentials:LGPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 SUITLAND TER SE APT A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1161
Mailing Address - Country:US
Mailing Address - Phone:765-602-3618
Mailing Address - Fax:
Practice Address - Street 1:2116 SUITLAND TER SE APT A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1161
Practice Address - Country:US
Practice Address - Phone:765-602-3618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00287101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty